scholarly journals Influence of sugammadex versus neostigmine for neuromuscular block reversal on the incidence of postoperative pulmonary complications: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jia-Feng Wang ◽  
Zhen-Zhen Zhao ◽  
Zheng-Yu Jiang ◽  
Hui-Xing Liu ◽  
Xiao-Ming Deng
Keyword(s):  
Respiratory Failure ◽  
Randomized Controlled Trials ◽  
Lower Risk ◽  
Neuromuscular Block ◽  
Meta Analysis ◽  
Pulmonary Complications ◽  
Controlled Trials ◽  
Postoperative Pulmonary Complications ◽  
Randomized Controlled ◽  
Postoperative Respiratory Failure

Abstract Background The influence of sugammadex for reversal of neuromuscular block (NMB) on postoperative pulmonary complications (PPCs), compared with neostigmine, remains to be determined. We performed a meta-analysis of randomized controlled trials (RCTs) to compare the incidence of PPCs between patients who received sugammadex versus neostigmine. Methods Relevant studies were obtained by searching the PubMed, Embase, and Cochrane Library databases. A random effects model incorporating the potential heterogeneity was used to pool the results. Results Fourteen RCTs including 1478 adult patients who underwent surgeries with general anesthesia were included, and of these, 753 received sugammadex and 725 received neostigmine for reversal of NMB. The pooled results showed that sugammadex was associated with a lower risk of overall PPCs compared to neostigmine (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.43–0.89, p = 0.01; I2 = 0%). This finding remained consistent after exclusion of two studies with potential overlapping events (OR: 0.58, 95% CI: 0.36–0.96, p = 0.03; I2=9%). Stratified analyses according to the categories of PPCs showed that sugammadex was associated with a significantly lower risk of postoperative respiratory failure (OR: 0.60, 95% CI: 0.38–0.97, p = 0.04; I2 = 0%) but not of postoperative pulmonary infection (OR: 0.79, p = 0.71), atelectasis (OR: 0.78, p = 0.33), or pneumothorax (OR: 0.87, p = 0.79). Conclusions Compared with neostigmine, the use of sugammadex for reversal of NMB was associated with a lower risk of PPCs, mainly due to a lower incidence of postoperative respiratory failure with the use of sugammadex.

scholarly journals The Effects of Intraoperative Inspired Oxygen Fraction on Postoperative Pulmonary Parameters in Patients with General Anesthesia: A Systemic Review and Meta-Analysis

2019 ◽  
Vol 8 (5) ◽  
pp. 583 ◽  
Author(s):  
Chang-Hoon Koo ◽  
Eun Young Park ◽  
Sun Young Lee ◽  
Jung-Hee Ryu
Keyword(s):  
Randomized Controlled Trials ◽  
General Anesthesia ◽  
Oxygen Concentration ◽  
Meta Analysis ◽  
Pulmonary Complications ◽  
Controlled Trials ◽  
Postoperative Pulmonary Complications ◽  
Randomized Controlled ◽  
Oxygen Fraction ◽  
Inspired Oxygen

High intraoperative inspired oxygen concentration is applied to prevent desaturation during induction and recovery of anesthesia. However, high oxygen concentration may lead to postoperative pulmonary complications. The purpose of this study is to compare the postoperative pulmonary parameters according to intraoperative inspired oxygen fraction in patients undergoing general anesthesia. We identified all randomized controlled trials investigating postoperative differences in arterial gas exchange according to intraoperative fraction of inspired oxygen (FiO2). A total of 10 randomized controlled trials were included, and 787 patients were analyzed. Postoperative PaO2 was lower in the high FiO2 group compared with the low FiO2 group (mean difference (MD) −4.97 mmHg, 95% CI −8.21 to −1.72, p = 0.003). Postoperative alveolar-arterial oxygen gradient (AaDO2) was higher (MD 3.42 mmHg, 95% CI 0.95 to 5.89, p = 0.007) and the extent of atelectasis was more severe (MD 2.04%, 95% CI 0.14 to 3.94, p = 0.04) in high intraoperative FiO2 group compared with low FiO2 group. However, postoperative SpO2 was comparable between the two groups. The results of this meta-analysis suggest that high inspired oxygen fraction during anesthesia may impair postoperative pulmonary parameters. Cautious approach in intraoperative inspired oxygen fraction is required for patients susceptible to postoperative pulmonary complications.

Dissociation of vasospasm-related morbidity and outcomes in patients with aneurysmal subarachnoid hemorrhage treated with clazosentan: a meta-analysis of randomized controlled trials

2013 ◽  
Vol 119 (1) ◽  
pp. 180-189 ◽  
Author(s):  
Jian Shen ◽  
Jian-Wei Pan ◽  
Zuo-Xu Fan ◽  
Xiao-Xing Xiong ◽  
Ren-Ya Zhan
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Randomized Controlled Trials ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Pulmonary Complications ◽  
Neurological Deficits ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Randomized Controlled

Object Clazosentan therapy after aneurysmal subarachnoid hemorrhage (SAH) has been found to be effective in reducing the incidence of vasospasm in randomized controlled trials. However, while vasospasm-related morbidity, including delayed ischemic neurological deficits (DINDs) and delayed cerebral infarctions, was consistently decreased, statistical significance was not demonstrated and outcomes were not affected by clazosentan treatment. The objective of this meta-analysis was to determine whether clazosentan treatment after aneurysmal SAH significantly reduced the incidence of DINDs and delayed cerebral infarctions and improved outcomes. Methods All randomized controlled trials investigating the effect of clazosentan were retrieved via searches with sensitive and specific terms. Six variables were abstracted after the assessment of the methodological quality of the trials. Analyses were performed following the method guidelines of the Cochrane Back Review Group. Results Four randomized, placebo-controlled trials met eligibility criteria, enrolling a total of 2181 patients. The meta-analysis demonstrated a significant decrease in the incidence of DINDs (relative risk [RR] 0.76 [95% CI 0.62–0.92]) and delayed cerebral infarction (RR 0.79 [95% CI 0.63–1.00]) in patients treated with clazosentan after aneurysmal SAH. However, this treatment regimen was not shown to outcomes including functional outcomes measured by Glasgow Outcome Scale-Extended (RR 1.12 [95% CI 0.96–1.30]) or mortality (RR 1.02 [95%CI 0.70–1.49]). Adverse events, including pulmonary complications, anemia, and hypotension, were all significantly increased in patients who received clazosentan therapy. Conclusions The results of the present meta-analysis show that treatment with clazosentan after aneurysmal SAH significantly reduced the incidence of the vasospasm-related DINDs and delayed cerebral infarctions, but did not improve poor neurological outcomes in patients with aneurysmal SAH. Further study is required to elucidate the dissociation between vasospasm-related morbidity and outcomes.

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